Robert W. Buckingham, a Yale graduate, is a professor of Public Health & Health Sciences at the University of Michigan-Flint, formerly appointed inaugural Executive Director/Dean of the School of Public Health with the University of Saskatchewan, in 2009. He has authored more than 12 books and many scientific referred papers, with the most recent being a textbook entitled, “A Primer on International Health” published by Allyn & Bacon, and five books on hospice care, including, “Care of the Dying Child” published by the Continuum Publishing Company, which was translated in seven languages. Dr. Buckingham helped pioneer the development of the first Hospice in the U.S. and considered one of the “Founding Fathers” of hospice in North America. He was the first Director of Research of hospice in Connecticut in 1974 and subsequently founded another 81 hospice programs worldwide, including a hospice for children afflicted with HIV/AIDS in Thailand. For his humanitarian work in the field of hospice care for children with AIDS, has been awarded the Ivanosky Prize in Humanitarian Medicine by the Russian Institute of Virology in 1992. In 2014, Dr. Buckingham was awarded the Nelson Mandela Award for Academic Leadership from Harvard University.
Mustafa Z. Younis is an internationally recognized scholar and an Expert of Global Health Financing & Public Health. He was a member of the Executive Committee of the International Society for Research of Healthcare Financial Management. Dr. Younis has authored and published over 200 articles, abstracts and presentations in refereed journals and meetings, and has presented at national and international conferences. Dr. Younis has administrative experience as Senior Advisor for the President at Zirve University, Turkey and as Chair of the Department of Health Policy and Management at Florida International University (FL, USA) where he led the accreditation efforts for the Healthcare Management Program. Dr. Younis has a history of playing visible roles on the editorial boards of journals as Chief Editor, Guest Editor and Editorial board member of leading journals such as IJMR, JHCF, Inquiry, JHHSA, JPBAFM Dr. Younis is a frequent speaker for both academic and professional audiences. His talks often feature his latest research and work in progress as well as cross-industry trends and strategy implications. He has provided workshops and presentation for wide organizations. His research and findings applied to for-profit, non-profit settings, and government. Dr. Younis has consulted with several organizations on Healthcare Finance and Economics. Dr. Younis is often invited to speak about the challenges in the healthcare industry and other related topics to health economics, finance, and research. He has presented topics, such as, healthcare reform, ownership structure, profitability, unit cost, payment system and efficiency in management, at a variety of forums and conferences in the United States, Europe, Asia, and the Middle East.
The recognition of unusual clusters of Pneumocystis carinii pneumonia and Kaposi sarcoma in 1981 among men who have sex with men in Los Angeles and New York was a public health warning for the beginning of the AIDS epidemic. Soon after, additional cases were identified among Haitians living in the United States and subsequently among previously healthy young adults in Haiti. Now, an estimated 36.9 million people are currently living with HIVreflecting a pandemic that is stabilizing but at an unacceptably levels. Low- and middle-income countries are disproportionately affected. Sub-Saharan Africa alone accounts for two-thirds of the global burden of HIV. Over the past two decades major global efforts have been mounted to address the epidemic, and significant progress has been made. The number of people newly infected with HIV, especially children, and the number of AIDS-related deaths have declined over the years, and the number of people with HIV receiving treatment increased to 21.7 million in 2017. There are yet remaining issues that continue to pose global public health challenges. Many people living with HIV or at risk for HIV infection do not have access to prevention, treatment, and care, and there is still no cure. More importantly, HIV primarily affects those in their most productive years, and it not only affects the health of individuals, but also impacts households, communities, and the development and economic growth of nations. Countries severely hit by HIV also face serious challenges due to other infectious diseases, food insecurity, and additional global health and development problems. Traditional prevention strategies include behavior change programs, condoms, HIV testing, blood supply safety, harm reduction efforts for injecting drug users, and male circumcision. However, numerous evidenced-based studies showed that engagement in HIV treatmentimproves individual health, and, significantly reduces the risk of transmission. Pre-exposure antiretroviral prophylaxis (PrEP) has also been shown to be an effective HIV prevention strategy in individuals at high risk for HIV infection. In 2015, the World Health Organization (WHO) recommended PrEP as a form of prevention for high-risk individuals in combination with other prevention methods. Several preventive strategies were proposed and implemented by the WHO and UNAIDS in the past decade including “90-90-90” targets – the major goal is to end HIV epidemic by 2030. For example, as of 2017, 75% of people living with HIV knew their status; among those who knew their status, 79% were accessing treatment; among those accessing treatment, 81% has their viral load suppressed, which exemplifies progress in the public health and care aspect of HIV/AIDDS. However, according to the UMAIDS, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia, the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.It is also alarming that public perception in many countries about the seriousness of HIV has declined in recent years. There is evidence that risky behaviors may be increasing among uninfected people. In summary, the lessons learned from HIV prevention and control efforts should fundamentally include public health monitoring to ensure that all HIV-infected patients receive quality care, providing public health support through referrals and assisting clinicians with outreach and partner notification.
Prof. Nassiri is a former Associate Dean of Global Health at the Michigan State University (MSU). He also served as MSU director of Institute of International Health. He is currently a faculty member of the departments of Pharmacology and Toxicology, and, Family and Community Medicine, and, lecturer in Global Health, Infectious Diseases, and Tropical Medicine. He currently works on international public health issues relating to chronic diseases and has expertise in global health. He has made contributions in various fields of medical sciences including clinical investigation and health education. On the basis of his extensive experience and expertise in chronic infectious diseases including HIV/AIDS, TB as well as antimicrobial resistance and human gut microbiome, he developed clinical research programs in Brazil, South Africa, Haiti, Dominican Republic, and Mexico. He had served as editorial board member for the Journal of HIV and AIDS Review. He is currently an editorial board member for AIDS Patient Care and STDs, and International Journal of Global Health. Prof. Nassiri has delivered seminar presentations on Tropical Medicine, HIV/AIDS, TB, Global Health and public health interventions in numerous national and international conferences and workshops. He is internationally recognized for his work in the areas of building effective international partnerships particularly in global health, community health, clinical care capacity building, and technical assistance mechanism. He has developed academic and research partnership programs with Federal University of Para Institute of Tropical Medicine in Belem, Brazil.
To find out the occurrence and to identify the possible risk factors related to reproductive tract infections among the women. It was a cross sectional study conducted among 214 women at selected hospital. Data were collected by questionnaire and observation check list. It was found that 29.9% of the RTI sufferers belonged to the age group between 25 years to 29 years. Cent percent of the respondents were married and those 57.0% who were married early suffered more. 82.2% were housewives and 39.3% of the husbands were engaged in non-government services. Practice of personal hygiene during menstruation showed reproductive tract infections were higher among the respondents having poor personal hygiene 69.2%. Twenty-eight percent of the respondents had history of abortion while 36.4% had menstrual regulation. 86.0% of the respondents had the history of contraceptive use where 57.6% were oral contraceptive pill users. In this study it was found that about half of the respondents had Candidial infections 50.47% followed by Trichomoniasis 23.36%, Gonorrhoea and Chlamydia infection 19.63% and 6.54% had multiple infections. The main symptoms as described by the respondents were vaginal discharge 92.5% where 54.5% were white curd like discharge. About 72.9% respondents had complaints of vaginal itching and 43.9% had burning / painful micturition. It was found that 65.4% had history of painful sexual intercourse. Effective preventive measures should be taken by the policy makers; otherwise it may bring about irreparable destruction not for those who are suffered but also the society.
Professor Dr. Mohammad Rezaul Karim have been working in National institute of Preventive and Social Medicine (NIPSOM) in the Department of Population Dynamics for the last seventeen years. I have worked in NIPSOM as a teacher, trainer and researcher. Now I am working as a Professor Department of Public Health in North South University in Dhaka. I did PhD, MPH and MBBS. I supervised thesis done by MPH and MPhil students about seventy-five in number. I have national and international publication about Sixty-five in number. I have presented my scientific research paper in different international conferences.
HIV Community Planning & Participatory Approaches to HIV Prevention
Participatory approaches to HIV prevention and treament require effective strategies by involving the community , which are critical in the conduct of scientific research and HIV programs. Community engagement brings mutual benefit to communities, programmers and researchers when both parties work together throughout the scientific research and program process. Community engagement can take different forms including information-giving, consultation, joint decision-making, acting together, and supporting independent community interests. As Baylor-Uganda site increased its capacity to conduct research and implement programs, the need for having a Community Advisory Board (CAB) that included different targeted community groups became more apparent. The site decided in establishing a novel model for CAB, which included three (3) sub-CAB groups each targeting a different communities. The three sub-CABs are: 1) Maternal and Child ; 2) Adolescent and Youth, and 3) Key Population/ Prioriety population. What makes this model different from what existed in Uganda, is having sub-CABs for reaching out to specific targeted population and direct involvment with research and programs. Selection of sub-CAB members from within the targeted community contributed to community confidence in each sub-CAB, enhancing its ability to act as an effective link between study team, implementing program staff and community. This contributed positively to the conduct of various research studies and enhanced community awareness and acceptance of the research and success of implementing programs. Having a strong and effective CAB with sub-CABs, each serving targeted population has resulted in increase in recruitment and retention for research and successful rolling out of programs.
Cissy Ssuuna has completed her Degree in Social Work and Social administration from Bugema University, a Diploma in Counseling & Diploma in Nursing from Mulago school of Nursing & Midwifery in Kampala Uganda She is a Community Educator and Prevention officer for Baylor Uganda Site in Kampala, Uganda. In addition, she is a member of HIV Prevention Trial Network (HPTN) Community Working Group. In her position at Baylor Uganda site, she is responsible for overseeing the community outreach and training. In this role, she directly liaise with research investigators and program managers to link them with their targeted communities
The mixed-method study examined knowledge and attitudes to HIV/AIDS of church-going adolescents in Jamaica. In addition to demographics, knowledge, and attitudes in this exploratory design, the main research question asked the preferred methods for receiving messages about HIV/AIDS prevention. This report discusses the qualitative phase of the three themes that emerged: social media, sexual practices, and tolerance for PLWHA. The findings will aid in the development of relevant age-appropriate, culture-specific, electronic intervention devices. These tools will facilitate the long-term research goal: to identify strategies to improve knowledge, and decrease risk behaviors to lower incidence of HIV/AIDS among our target population.
Dr. Corinne Barnes completed her PhD at Atlantic International University and is a lecturer at University of the West Indies. She is the coordinator director for the Undergraduate Programs at Caribbean School of Media and Communication Relations (CARIMAC) UWI Campus in Jamaica and has received funding support from the university to support her work on HIV/AIDS and Media. Dr Barnes has also published in peer-reviewed journals
Introduction: Isoniazid preventive therapy (IPT) is an intervention recommended by the WHO for prophylaxis of Tuberculosis (TB) in people living with HIV (PLWH) and reported as generally safe with little risk of hepatotoxicity. Following its introduction in Eritrea in 2014, IPT related hepatotoxicity and fatality have been reported frequently to the Eritrean Pharmacovigilance Centre. The aim of this study is, therefore, to quantify the risk of hepatotoxicity, evaluate the effectiveness of close laboratory monitoring, assess the causal relationship of IPT and hepatotoxicity, identify possible risk factors and assess preventability of Isoniazid-induced hepatotoxicity in PLWH. Methods: This was a seven-month observational cohort study of PLWH on IPT enrolled from three ART sites in Asmara, Eritrea, between August 2016 and February 2017. Causality and preventability of the cases was assessed using Naranjo probability scale and P-method respectively. Results: Of the 360 eligible patients, 56 were identified with hepatotoxicity with an incidence rate of 37 cases per 1000 person-months. The median time to reaction onset of the hepatotoxicity was 34 days and about 41% of the cases developed severe or very severe hepatotoxicity following initiation of IPT. INH was terminated in 78.6% of the cases and reaction abated in 84.1% (37/44) following withdrawal of INH. Besides, Antiretroviral therapy was discontinuedin 42.5% of the cases due to hepatotoxicity. In majority of the cases (87.5%), the causal relationship was found to be ‘probable’ and in 82.1% hepatotoxicity was not preventable. Conclusions:There appears to be a higher incidence rate of INH-related hepatotoxicity with a very short time to reaction onset. Though fatalities might have been prevented with the monthly laboratory monitoring, the occurrence of severe and very severe hepatotoxicity was unavoidable in substantial number of patients; making risk minimization plan and IPT deployment challenging.
In spite of the huge conventional mass media campaign on HIV prevention in Ghana and its attendant high public awareness, there is low level adoption of some preventive measures by the public due to their limited involvement in the communication process as well as a knowledge gap about the disease as confirmed by Ghana Demography and Health Survey (GDHS) of 2014. This questioned the impact of conventional communication channels and shifted focus to community radio, regarded as a grassroots medium that accentuates the voices and participation of people in addressing issues that affect them. This study, therefore, is aimed at understanding the role of community radio as a participatory health communication mechanism in preventing the spread of HIV/ AIDS among the rural and semi-urban population in Ghana. The study specifically examined the current state of community radio HIV/AIDS programming in Pokuase and Winneba communities in Ghana; the extent to which knowledge, attitudes and practices relating to HIV/AIDS are influenced by community radio as well as identified how community radio can be deployed to strengthen communication and improve HIV preventive measures uptake by the community members. Based on a sample size of 824 respondents and 12 Key Informant Interviewees, the study confirmed a high-level awareness of HIV epidemic in the sampled communities due to the participatory programming of Radio Emashie, Pokuase and Radio Peace, Winneba. The findings further revealed that community members have adopted certain behaviours such as the use of condoms, faithfulness to partners and limited number of sexual partners in order to prevent HIV infection. Therefore, the study recommended increased funding to strengthen participatory approach to radio programming and increased frequency of HIV-related youth-focused programmes to prevent new infections. The study highlighted the installation of Radio Peace transmitter on Vodafone telecom base-station to ensure uninterrupted broadcast, as a key lesson derived for sustainable community radio operation in Nigeria.
Oluseyi Soremekun has completed his PhD in Development Communication from the Ahmadu Bello University, Zaria Nigeria. He is the National Information Officer of the United Nations Information Centre (UNIC) in Nigeria, a field office of the Department of Global Communication (DGC), UN Secretariat New York. He has over 29 years of uninterrupted communication practice and has published five papers in reputed journals/ academic books and over 15 communication-related articles in professional magazines
Sexual Health Promotion
According to The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), approximately 33.4 million individuals throughout the world have been affected by HIV/AIDS in the last 30 years or so (Bonacquisti & Geller, 2013). The medication, Truvada, otherwise known as PrEP, has been introduced to serve as a harm reduction technique to combat the spread of HIV infection. PrEP is an antiretroviral drug that lowers the risk of HIV exposure. This is a qualitative study examining the sexual behaviors of gay and bisexual men prescribed PrEP as a preventive method for the transmission of HIV. I conducted 30 semi-structured in-depth interviews of people who had been prescribed PrEP for at least 30 days in three cities: Los Angeles, Philadelphia, and New York City. The results indicate that contextual factors shaped the sexual behaviors of participants on PrEP, leading them to lower risk at times, and elevate it at others. PrEP caused individuals to experience changes within their communication patterns with their medical providers and their sexual partners. The results shed light on the way people on PrEP engage in sexual and health-seeking behaviors, and help to develop a blueprint for the way service providers engage with this community. KEY WORDS: PrEP (Pre-exposure Prophylaxis); HIV /AIDS; Truvada; HIV prevention; harm reduction; risky sexual behaviors; Cognitive Behavioral Therapy (CBT); Relational Cultural Therapy (RCT); qualitative interviews
Michael Kaltenbach is a Part-time Lecturer at Rutgers University School of Social Work in Newark, NJ and an Adjunct Lecturer at Smith College in Northampton, MA. He has previously taught BSW and MSW level courses in crisis intervention and brief therapy, clinical assessment & diagnosis (psychopathology), social work practice with individuals and families, intro. to social welfare / human services, communication in social work practice, human behavior and the social environment, and emotional disorders in childhood and adolescents at Temple University and the University of Southern California.
Background: There is a continuous rise of Gonococcal Neisseria (GC) and Chlamydia Trachomatis Gonorrhea (CT) among the youth and young adults in the United States, despite advance treatment and management guidelines in place. A total number of 1,598,354 cases of CT, and 468,514 cases of GCwere reported in 2016, rates increase from 251.4 to 497.3 per 100,000 people between 2010 to 2016. Evidence suggests that risky sexual behaviors and lack of knowledge contribute to this problem; targeted educational and behavioral counseling could help in reducing the incidence and repeat or reinfection rates among adolescents and young adults. Method: This DNP project was developed to test the feasibility of an educational and behavioral counseling intervention about the spread, symptoms and complications of GC/CT among adolescent and young adult female in Newark New Jersey. The participants (12 adolescents and young adult females’ ages 13 to 24 years) received a total of three sessions of educational and behavioral counseling on GC and CT in three days, each session lasted about 40-60. At the completion of the sessions participants took the posttest and a satisfaction (evaluation) survey. Result: The results indicated that all participants (n=12) improved in their knowledge about STDs especially GC/CT with p value =. 016. While most of the participants (n= 11) improved in their knowledge of the symptoms associated with GC/CT identifying correctly that most women will not have symptoms when infected with GC/CT (p= .002). Knowledge about the preventions of the complications associated with GC/CT was also tested among the participants, and the results indicated that almost all the participants (n=11) had improved knowledge as indicated by the posttest scores and p value =.004 and .039 respectively. Conclusion: Educational/behavioral-counseling program on GC/CT in a local community as Newark had a positive impact on the adolescent and the young adult females who participated.
A DNP (executive model) graduate from Rutgers School of Nursing Newark New Jersey. A qualified graduate of Master of Science in Nursing, Family Nurse Practitioner (FNP), with proven strengths in acute care and family practice, with extensive patient care experience in emergency department, telemetry, Step down ICU, behavioral health, and pediatrics. As a FNP in the heart of the city of Newark, I developed an educational program on how to improve treatment outcome by reducing reoccurrence and complications among teen and young adult female positive for Gonorrhea/Chlamydia in Newark community.
Background Globally 2.1 million People Living with HIV (PLHIV) are aged 10-19 yrs. Two million adolescents living with HIV/AIDS are in Sub Saharan Africa (SSA) and 70% are in 10 countries, Uganda inclusive. Only 20% of the estimated 11,000 Ugandan adolescents living with HIV are in care. There is inadequate data on adolescent uptake of Sexual Reproductive Health (SRH) services. This was a quality improvement project undertaken to improve uptake of SRH services among HIV infected adolescents attending the Baylor Uganda clinic from 0.8% to ≥50% between June and December 2018. Description of the Problem Despite establishment of SRH unit uptake of SRH services, uptake among adolescents has remained very low at 0.8% below the national achievement of 20%. The causes of this low uptake include: • Low awareness among adolescents on availability of SRH services. • Misconception that SRH is only about screening for cancer of the cervix which was thought to be a painful procedure and therefore shunned • Male adolescents felt that SRH services were only for females • Health workers were judgmental and asked disabling questions like why adolescents have sex before marriage, • Lack of team work on the part of health workers since they left awareness and provision of SRH services to only two nurses. Tested Changes Training adolescent peer leaders on SHR services, creating awareness on the availability of SRH services, develop a referral criterion to guide and prioritize adolescents in much need of SRH services like post abortion adolescents and teen mothers and strengthening Monitoring and evaluation through establishing a SRH register. Outcome Uptake of SRH services among HIV infected adolescents improved from 0.8% in June 2018 to 53% in December 2018. Lessons Learnt • Adolescents need to be physically walked and linked to SRH service points • Peer led health services are more appreciated by adolescents • Team work is key for projects to succeed we must work as a team
Introduction: Heterosexuality is the most common form of sexual orientation in the world. Other forms of sexual orientations such as homosexuality, bisexuality and asexuality are characterized as abnormal and viewed as deviations from normal sexuality. While anyone who has, sex can have a risk of developing sexually transmitted infections and men who have sex with men (MSM) are even at greater risk. Objective: To assess sexual transmitted infection risk and health service access among men sex with men in Addis Ababa. Methods: Qualitative study with phenomenological method wasused toassess sexual transmitted infection risk among men having sex with men in Addis Ababa from June 16, 2017- November 10, 2018. Snowball sampling method was used to recruit men having sex with men. Data was analysed using Narrative Analysis method. Results:A total of 40 study participants were involved in the study. The main reasons to engage in to this life are the way they grown up, pornography, reading books, taking an open bath in a river, being a rape victim and believing that it is their nature. MSMs were at high risk of STI due to having multiple sexual partners, not using condom, torn of condom, absence of anal condom, swapping of sexual partner, intoxication and using other drugs. Majority of the study participants have visited health center due to their illness. However, some of the study participants prefer to treat themselves at home or use medicine they get from pharmacy without health professionals prescription. There is a reproductive health strategy including family planning, sexual behavior education and others but there is no any special program and/ or policy that address STI risk among MSM. Moreover, health care providers are trained on how to treat STI but not specifically for MSM. However, anyone who develops STI can get the service in health facilities without any discrimination. Conclusions:The main reasons to engage in to this life are the way they grown up, pornography, reading books, taking an open bath in a river, being a rape victim and believing that it is their nature. MSMs were at high risk of STI and majority of the study participants have visited health center due to their illness. There is a reproductive health strategy but there is no any special program and/ or policy that address STI risk among MSM. However, anyone who develops STI can get the service in health facilities without any discrimination. Recommendations:The needs of this special group and their sexual rights should be acknowledged by the health policy makers. There should be policies and guidelines that target the need of MSM in the country including prevention and treatment packages.Health professionals must well trained and give the appropriate treatment without any discrimination of their sexual orientation. Keywords:Men having sex with men, sexual transmitted infection, Addis Ababa, Ethiopia
HIV Testing Programs in Health Care and Non-Health Care Settings
The study investigated HIV Testing and condom use preventive measures against the continued spread of HIV among sex workers. The study also investigated the effectiveness of HIV testing as a community-based intervention for HIV prevention and promotion of save sexual behavior among female workers. 100 sex workers were randomly selected from the groups of sex workers from the major towns of Ekiti State. A set of 10 questions were used to obtain information concerning how often respondent in the past 12 months have asked a new sex partner how he felt about using condom and the need for both of them and their partners to get tested for HIV before having sex. The questionnaire was adopted from “health protective sexual communication scale” of Yabberetal. The appropriate statistical techniques such as the Means, Frequency Counts and Percentage were used to describe the data. The study revealed the extent of HIV testing and condom use among sex workers. The study also shows the opinion of sex workers concerning HIV as a community-based intervention for HIV prevention.
Akanle FlorenceFoluso has completed his PhD from Ekiti State University, Ado-Ekiti, Nigeria and she is Senior Lecturer, She is a specialist in sexuality, she has published more than 50 papers in reputed journals and has been serving as an editorial board member of repute.
BACKGROUND Risk behavior resultingin HIV vulnerability promptsMSM to seek HIV testing.This study was aimed at comparing recent risk behaviour amongst MSM first-time and repeat testers at aCommunity Health Center in Lagos, South West Nigeria. METHODS: HIV testing was provided to 1,236MSM of a median age of 25 years (range 16-50)who were either first-time or repeat testers at a trusted community health centre. These MSM were interviewed, counseled, and tested for HIV using the National HIV Testing Services (HTS) client intake form between October 2017 – September 2018. Analyses wererestricted to MSM who reported never testing for HIV or whose last test result wasnegative. RESULTS: First time testers accounted for 44.9% of the participants while repeat testers accounted for 55.1% out of which 2.8% had tested in less than a month, 23.1% tested in less than 3 months, 71.4% had tested in less than 6 months while 2.8% were testing after 6 months.Proportion of first-timers reporting sexually transmitted infections was 18% compared to 7% among repeat testers. While 77% of first-time testers reported unprotected anal sex with their male partners in the last 6 months, 70% of repeat testers reported doing so. Twenty-eight percent of first-time testers paid for sex in the last 6 months compared to 2% among repeat testers. The proportion of first-time testers who had more than 1 sexual partner in the last 6 months was 89% compared with 83% among repeat testers. HIV positivity among first time testers was 31% and among repeat testers was 23%. CONCLUSIONS: The study shows MSM first-time testersare at a higher risk of acquiring HIV compared to repeat testers. There is a critical need to implement more targetedbehavioural interventions that will identify, educate MSMat highest risk for HIV, conduct timely HIV testing and link HIV positive MSM to appropriate care and treatment services